Provider Demographics
NPI:1831116524
Name:GLENDALE MEDICAL ARTS CENTER PHARMACY INC.
Entity Type:Organization
Organization Name:GLENDALE MEDICAL ARTS CENTER PHARMACY INC.
Other - Org Name:GLENDALE MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKHTARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-500-0800
Mailing Address - Street 1:1030 S GLENDALE AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-5612
Mailing Address - Country:US
Mailing Address - Phone:818-500-0800
Mailing Address - Fax:818-500-8527
Practice Address - Street 1:1030 S GLENDALE AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5612
Practice Address - Country:US
Practice Address - Phone:818-500-0800
Practice Address - Fax:818-500-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY309343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0581947OtherNABP
CA0748820001Medicare ID - Type Unspecified